Jonathan Fleischacker Mattanah, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3649 Issued in MD

Practice address

6525 N Charles St
Gibson Building, West Wing, Suite 244
Towson, MD 21204-6872

Phone

(410) 938-8457

Fax

(410) 825-7105

NPI assigned

Feb 26, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Anxiety and Stress Disorders Institute of MarylandGroup PAC ID 1850341215, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anxiety and Stress Disorders Institute of Maryland

  • Professional Counselor
  • Towson, MD
  • NPI 1154422731
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750417598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6525 N CHARLES ST",
            "address_2": "GIBSON BUILDING, WEST WING, SUITE 244",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212046872",
            "telephone_number": "410-938-8457",
            "fax_number": "410-825-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 N CHARLES ST",
            "address_2": "GIBSON BUILDING, WEST WING, SUITE 244",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212046872",
            "telephone_number": "410-938-8457",
            "fax_number": "410-825-7105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTANAH",
        "first_name": "JONATHAN",
        "middle_name": "FLEISCHACKER",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MD",
            "license": "3649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matclinic Physicians Practice Group LLC
• Matclinic Physicians Practice Group LLC
• Bobby Varghese Mathew
• Maria Matos-Crowl
• Jeremy Mattanah
• Karen Mattes, PTA
• Earl Craig Matthews, MD
• Kelwan Matthews
• Rachel Courtney Matyja, LCPC
• Maureen Batza Morris, PSYD, LLC

• Clinical Psychologist in Towson, MD
• Providers in Towson, MD by specialty
• Clinical Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.